Primary health care practitioners' tools for mental health care

The purpose of this study was to describe and analyse the content of mental health care from the practitioner's point of view. The specific aim of this paper was to outline the types of mental health care tools and the ways in which they are used by primary health care practitioners. The data were derived from interviews with doctors and nurses (n = 29) working in primary health care in six different health care centres of the Pirkanmaa region in Finland. The data were analysed by using qualitative content analysis. The tools of mental health care used in primary health care were categorized as communicative, ideological, technical and collaborative tools. The interactive tools are either informative, supportive or contextual. The ideological tools consist of patient initiative, acceptance and permissiveness, honesty and genuineness, sense of security and client orientation. The technical tools are actions related to the monitoring of the patient's physical health and medical treatment. The collaborative tools are consultation and family orientation. The primary health care practitioner him/herself is an important tool in mental health care. On the one hand, the practitioner can be categorized as a meta-tool who has control over the other tools. On the other hand, the practitioner him/herself is a tool in the sense that s/he uses his/her personality in the professional context. The professional skills and attitudes of the practitioner have a significant influence on the type of caring the client receives. Compared with previous studies, the present informants from primary health care seemed to use notably versatile tools in mental health work. This observation is important for the implementation and development of mental health practices and education.     

Access to Health Care

Purpose: To describe and analyze conceptual and operational definitions of health care access for future nursing theory, practice, and policy. Access to health care is a major health policy concern. However, the elements of access to care are not well understood. As a result, how access is addressed is often inconsistent and unclear.
Organizing construct: Walker and Avant's framework for concept analysis.
Sources: Published literature in nursing and health services from the 1960s to the 1990s. The analysis was done in 1997 for this integrative review of nursing and nonnursing literature.
Methods: Integrative literature review in 1997.
Findings: Access is a complex idea defined in many ways. One of the most comprehensive definitions of access is by the World Health Organization (WHO). Multidementional barriers and facilitators to access vary by community and country.
Conclusions: Societies may define access differently at different stages of development. Scales to measure some dimensions of access are available; however, newer and better measures are needed and are being developed and tested. Data on each of the dimensions are needed for comprehensive assessment of access to health care in all countries at all stages of development.     

发挥护理专业优势强化"四个贴近"夯实新世纪城市卫生服务基础

介绍了大庆市卫生局发挥护理专业优势 ,把护理工作延伸到社区 ;发挥护士素质特长 ,把健康理念落实到社区 ;发挥护士特有的潜能 ,全心全意服务于社区。通过社区护理工作 ,使卫生服务更加贴近社区、贴近家庭、贴近百姓、贴近生活。保证全市人民“生能顺利、病能医治、老能康乐、死能安息。”的具体做法和成效。     

社区高血压患者的护理模式的探讨

目的 探讨居家护理对高血压患者血压控制及依从性的影响.方法 以性别、年龄、高血压等级为配对条件,筛选80例(40对)满足配对的高血压患者随机分为居家组和常规组,每组40例.居家组给予程序式居家护理、常规组常规性社区护理,共干预6个月.结果 两组患者干预3、6个月后降压效果及依从性差异均存在显著性意义(P＜0.05).结论 程序式居家护理可提高高血压患者的依从性,促进血压的降低,有利于患者生存质量提高,同时具有可操作性与实用性,值得在社区护理中推广应用.     

A Universal Healthcare System: Is It Right for the United States?

The over 45 million Americans who are uninsured speak volumes about the problems with our present healthcare system. Many Americans do not have access to basic health care and it is time to revisit the importance of universal health care for all Americans. PURPOSE: To gain a greater understanding of the facts, figures, and support for universal health care in America. SOURCE OF INFORMATION: A literature review of five research studies. CONCLUSION: The implementation of universal health care in America is a plausible feat, but the support of several facets of society is necessary for this to become a reality.     

Barriers to preventive health care for young children

PURPOSE: To review the literature on barriers to availability, access, and utilization of preventive health care for young children three to five years of age and their families and to discuss the role of nurse practitioners (NPs) in future research, education, and practice in this area. DATA SOURCES: A comprehensive literature search was conducted of online material and CINAHL and Medline (CD-ROM 1990 to present). In addition, experts in this area were asked to recommend extra reading materials. Additional references in textbooks and articles were examined. CONCLUSIONS: The literature review supports that there are major barriers to be addressed in the areas of availability, access, and utilization of preventive health care services for young children and their families. Major concerns include mandatory system for preventative health care, lack of health insurance coverage, cultural issues, and parental effects. IMPLICATIONS FOR PRACTICE: Health professionals in the community will need to work together to reevaluate current preventive health care practices for young children. Alternative methods for approaching and providing preventive health care services may become increasingly important if these services for young children are to be provided at current or increased levels.     

Australian evidence for interprofessional education contributing to effective teamwork preparation and interest in rural practice

A pilot interprofessional education (IPE) placement for undergraduate health care professional students was undertaken in rural Victoria, Australia from 2001 to 2003. Medical, nursing, physiotherapy and pharmacy students were involved, and the project is ongoing. This paper briefly outlines the educational model, then focuses on the evaluation methods and results obtained from student evaluations. The placement experience improved self-reported teamwork skills and knowledge, and supported participating students' belief in the value of interprofessional practice. Placements strengthened nursing and allied health students' intention to work in rural health settings after graduation. The rural interprofessional educational experience improved interprofessional abilities in a group of students who have the potential to influence change towards collaborative practices in their future workplaces. The results obtained provide sufficiently strong evidence to justify the continuation and expansion of this educational model in the Australian setting. Pedagogical and evaluation modifications are discussed that may benefit future IPE programs.     

Association between continuity of care in Swedish primary care and emergency services utilisation: a population-based cross-sectional study

Objective: The primary objective of this study was to determine the association between longitudinal continuity of care (CoC) in Swedish primary care (PC) and emergency services (ES) utilisation.

Study design: A cross-sectional analysis of longitudinal population data. Setting. PC centres, out-of-hours PC facilities and emergency departments (EDs) in Blekinge County in southern Sweden. Subjects: People of all ages who lived in Blekinge County and who had made two or more visits per year to a general practitioner (GP) during office hours from 1 January 2012 to 31 December 2014.

Main outcome measure: ES utilisation.

Results: Eight-thousand one-hundred and eighty-five people were included in the study. CoC was quantified using three different indices—Usual Provider of Care index (UPC), Continuity of Care index (CoCI), and Sequential Continuity index (SECON). The CoC that the PC centres could offer their enrolled patients varied significantly between the different centres, ranging from 0.23–0.57 for UPC, 0.12–0.43 for CoCI, and 0.25–0.52 for SECON. Association between the three CoC indices and ES utilisation was computed as an incidence rate ratio which ranged between 0.50 and 0.59.

Conclusion: Longitudinal CoC was shown to have a negative association with ES utilisation. The association was significant and of a magnitude that implies clinical relevance. Computed incidence rate ratios suggest that patients with the lowest CoC had twice as many ES visits compared to patients with the highest CoC.     

Personal access to health care: a concept analysis

The objective of this concept analysis was to formulate an operational definition, so that those seeking, providing, and legislating health care policy would share a common interpretation of the concept. A concept analysis following the strategy suggested by Walker and Avant was used to identify antecedents, attributes, and empirical referents of access to health care. Furthermore, model, borderline, contrary, and invented cases were described. A theoretical definition was derived, which will lead to a better understanding of the concept and bring the concept closer to measurability and readiness for an operational definition. Access to health care has been addressed in political campaigns, studied by numerous legislative committees, and purported to be in an emergency state of despair. However, a measurable definition of access to health care continues to elude providers and legislators of health care; in as much, the meaning of the concept varies with the user.     

Evidence-based health care: challenges and limitations

There has been an exponential growth in the interest in evidence-based health care (EBHC) since the term was first coined. With this interest, discussions arise about potential challenges and limitations to the practice of EBHC including the need for developing new skills, the need to have access to evidence, and the scarcity of evidence in support of its practice. Some of these challenges have been met but there is still work to be done in this field. In particular, attention must be paid on ensuring ready access to high quality evidence for all end-users. This journal is attempting to meet this need for speech-language pathology.     

Trends in the perceived complexity of primary health care: a secondary analysis

Rationale If the complexity of the patient's medical problems increases or the complexity of the interactions between the doctor and the patient, the staff or the health care system increase, then complexity of patient care will increase. This study examined trends in patient complexity, and identified doctor, practice and improvement strategy characteristics associated with perceived complexity. Methods This secondary analysis used data from three Community Tracking Surveys with 22 134 primary care doctors completing surveys about themselves, their practice setting, practice improvement strategies and complexity of care in three consecutive 2‐year time periods (1996–1997, 1998–1999, 2000–2001). Data were analysed using hierarchical logistic regression. Results The proportion of primary care doctors who perceived that complexity of care had increased over the past 2 years rose from 31.5% to 35.9%. Perceived complexity of patient care was consistently related to being in solo practice and the belief that they could not frequently obtain high‐quality services and referrals for patients. As availability of services increased, complexity decreased whereas as use of practice improvement strategies increased, complexity also increased. Conclusions Understanding that we cannot determine whether respondents understood care as ‘complicated’ or ‘complex’, potential consequences of this increase in complexity include an increase in medical errors and referral rates along with decreased quality of patient care and career satisfaction.     

Parental Perceptions of Health Care for Children with Chronic Illness-A Population-based Study in a Swedish Primary Care District

The division of responsibilities between specialized and primary health care for children with chronic illness is unclear. The utilization and perceptions of primary and specialized care were examined by means of a questionnaire mailed to the parents of all chronically ill children and a randomly selected control group. No difference in sociodemographic variables of responders (70%) and nonresponders was found. The study comprised 98 index and 168 control children. The index children utilized both primary and specialized care more than controls. The overall satisfaction with health care was high, but primary care did not come up to the expectations of many chronically ill children's parents. Satisfaction with specialized care but not with primary care had improved during the previous 15 years. Recognition in primary care of childhood chronic illnesses and their psychosocial consequences is important. In co-operation, the two health care levels together could enable a comprehensive, well-coordinated, and continuous care for these children.     

Resource consumption and costs of palliative care services in Spain: a multicenter prospective study

Patients (n = 395) with terminal-stage cancer receiving attention from palliative care services (PCSs) were recruited over a period of 15 consecutive days from 171 participating PCS units. Resource consumption and costs were evaluated for 16 weeks of follow-up, and the findings were compared with a study conducted in 1992 so as to assess change over time. The most frequent health care interventions were homecare visits, hospital admissions, and patient-consultant phone calls. PCS provided 67% of all services and consultation interventions in 91% of patients. Compared with the historical data, there was a significant shift from the use of conventional hospital beds toward palliative care beds, a reduced hospital stay (25.5–19.2 days; P = 0.002), an increase in the death-at-home option (31%–42%), a lower use of hospital emergency rooms (52%–30.6%; P = 0.001), and an increase in programmed care. Compared to the previous resource consumption and expenditure study in 1992, the current PCS policy implies a cost saving of 61%, with greater efficiency and no compromise of patient care.